Injury to the Developing Lung: experimental and clinic al aspects

Injury to the developing lung or disturbance of normal lung development may lead to a chronic lung disease, bronchopulmonary dysplasia (BPD), which may have long-term effects. BPD is characterized by an arrest of development of the lung and the pulmonary vascular system and occurs in around 20% of ventilated newborns. In the first part of this thesis, different factors that influence the development of BPD are studied, both in an experimental and a clinical setting. We found that components of the TGF-b/BMP signalling pathway play a central role in normal and abnormal late lung development. In addition, angiogenic factors, inflammatory cytokines and the nitric oxide system are shown to be of influence. Another factor in the aetiology of BPD is intra-uterine growth retardation. The second part of this thesis focuses on surfactant treatment in acute neonatal lung disorders. Surfactant therapy has become the standard therapy for respiratory distress syndrome in premature infants. There is a significant amount of evidence that near-term or term infants, as well as children, with acute respiratory failure have a profound functional surfactant deficiency. In an experimental setting, we compared synthetic versus natural surfactant and we demonstrated for the first time that both types of surfactant have a positive influence on lung function. However, synthetic surfactant had a significantly stronger effect on inflammatory cytokines. Thus, synthetic surfactant may cause less chronic lung disease and it may be an important part of treatment of these infants in the future

Invasive ventilation modes in children: a systematic review and meta-analysis

Introduction: The purpose of the present study was to critically review the existing body of evidence on ventilation modes for infants and children up to the age of 18 years.Methods: The PubMed and EMBASE databases were searched using the search terms 'artificial respiration', 'instrumentation', 'device', 'devices', 'mode', and 'modes'. The review included only studies comparing two ventilation modes in a randomized controlled study and reporting one of the following outcome measures: length of ventilation (LOV), oxygenation, mortality, chronic lung disease and weaning. We quantitatively pooled the results of trials where suitable.Results: Five trials met the inclusion criteria. They addressed six different ventilation modes in 421 children: high-frequency oscillation (HFO), pressure control (PC), pressure support (PS), volume support (VS), volume diffusive respirator (VDR) and biphasic positive airway pr

Does a narrative retelling task improve the assessment of language proficiency in school-aged children born very preterm?

Almost half of the children born very preterm (VP) experience language difficulties at school-age, specifically with more complex language tasks. Narrative retelling is such a task. Therefore, we explored the value of narrative retelling assessment in school-aged children born VP, compared to item-based language assessment. In 63 children born VP and 30 age-matched full-term (FT) controls Renfrew’s Bus Story Test and Clinical Evaluation of Language Fundamentals were assessed. The retelling of the Bus Story was transcribed and language complexity and content measures were analyzed with Computerised Language Analysis software. Narrative outcomes of the VP group were worse than that of the FT group. Group differences were significant for the language complexity measures, but not for the language content measures. However, the mean narrative composite score of the VP group was significantly better than their mean item-based language score, while in the FT group the narrative score was worse than the item-based score. Significant positive correlations between narrative and item-based language scores were found only in the VP group. In conclusion, in VP children narrative retelling appears to be less sensitive to detecting academic language problems than item-based language assessment. This might be related to the mediating role of attention in item-based tasks, that appears not to affect more spontaneous language tasks such as retelling. Therefore, in school-aged children born VP we recommend using narrative assessment, in addition to item-based assessments, because it is more related to spontaneous language and less sensitive to attention problems

Towards a quieter Neonatal Intensive Care Unit: Current approaches and design opportunities

Recent studies show that the well-being of patients and the performance of healthcare professionals in modern neonatal intensive care units (NICUs) are severely affected by the amount of auditory alarms and sound nuisance. This paper presents a semi-systematic review on the topic of environmental sound in the NICU, where current themes, insights, and limitations are highlighted. Furthermore, it outlines the results of an observation of the NICU environment and an interview with nurses at Erasmus Medical Center, in order to understand the users, their context, and the technology that can enable design interventions. The insights gathered from the literature and the users, together with a technology search, lead to potential design opportunities to be developed further. Based on these, we propose a technological solution towards a healthy sound environment in the NICU

Knowledge Gaps in the Fetal to Neonatal Transition of Infants With a Congenital Diaphragmatic Hernia

Clinical research for infants born with a congenital diaphragmatic hernia (CDH) has until recently mainly focused on advances in prenatal and postnatal treatment. However, during the early perinatal transition period there are major physiological adaptations. For most infants these changes will happen uneventfully, but for CDH infants this marks the beginning of serious respiratory complications. In recent years, there is emerging evidence that the clinical management during the perinatal stabilization period in the delivery room may influence postnatal outcomes. Herein, we discuss major knowledge gaps and novel concepts that aim to optimize fetal to neonatal transition for infants with CDH. One such novel and interesting approach is performing resuscitation with an intact umbilical cord, the efficacy of this procedure is currently being investigated in several clinical trials. Furthermore, close evaluation of neonatal physiological parameters in the first 24 h of life might provide early clues concerning the severity of lung hypoplasia and the risk of adverse outcomes. We will provide an overview of trending concepts and discuss potential areas for future research

Dynamic Light Scattering: A New Noninvasive Technology for Neonatal Heart Rate Monitoring

Background: Heart rate (HR) detection in premature infants using electrocardiography (ECG) is challenging due to a low signal amplitude and the fragility of the premature skin. Recently, the dynamic light scattering (DLS) technique has been miniaturized, allowing noninvasive HR measurements with a single sensor. Objective: The aim was to determine the accuracy of DLS for HR measurement in infants, compared to ECG-derived HR. Methods: Stable infants with a gestational age of ≥26 weeks, monitored with ECG, were eligible for inclusion. HR was measured with the DLS sensor at 5 different sites for 15 min each. We recorded every 10th second of the DLS-derived HR and the DLS signal-to-noise ratio (SNR), and the ECG-derived HR was extracted for analysis. Patients were randomly divided into 2 groups. In the first group, the optimal SNR cut-off value was determined and then applied to the second group to assess agreement. Results: HR measurements from 31 infants were analyzed. ECG-DLS paired data points were collected at the forehead, an upper extremity, the thorax, a lower extremity, and the abdomen. When applying the international accuracy standard for HR detection, DLS accuracy in the first group (n = 15) was optimal at the forehead (SNR cut-off 1.66). Application of this cut-off to the second group (n = 16) showed good agreement between DLS-derived HR and ECG-derived HR (bias –0.73 bpm; 95% limits of agreement –15.46 and 14.00 bpm) at the forehead with approximately 80% (i.e., 1,066/1,310) of all data pairs remaining. Conclusion: The investigated DLS sensor was sensitive to movement, overall providing less accurate HR measurements than ECG and pulse oximetry. In this study population, specific measurement sites provided excellent signal quality and good agreement with ECG-derived HR